25C-103 MU LTI — FAMILY PIZ ®PER 'F\
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31 -33 Grant Avenu Northa mpt on, MA 01060
•
NEW ENGLAND LAND SURVEY MORTGAGE INSPECTION PLAN
Professional Land Surveyors NAME JOHN F. GNATEK A VICTORIA A. GNATEK
5 Wheelock Street
Oxford, MA 01540 LOCATION 31 -33 GRANT AVENUE
PHONE: (508) 234-3493 NORTHAMPTON, MA
FAX: • (508) 234-7723 SCALE 1" -20 DATE 10/29/2009
REGISTRY HAMPSHIRE .
BASED UPON DOCUMENTATION PROVIDED, REQUIRED MEASUREMENTS • LENDER: Greenfield Savings Bank
WERE MADE OF THE FRONTAGE AND BUILDING(S) SHOWN ON THIS
MORTGAGE INSPECTION PLAN. IN OUR JUDGEMENT ALL VISIBLE EASEMENTS °F
ARE SHOWN AND THERE ARE NOVIOLATIO 6F ZONINOREOUIREMENT5 � N DEED BOOK /PACE: 1182/
REGARDING STRUCTURES TO PROPERTY LINE OFFSETS (UNLESS
OTHERWISE NOTED IN DRAWING BELOW). NOTE: NOT DEFINED ARE JAMES PLAN BOO PLAN N/A
ABOVEGROUND POOLS, DRIVEWAYS, OR SHEDS WITH NO FOUNDATIONS. PAIR
THIS IS A MORTGAGE INSPECTION PLAN: NOT AN INSTRUMENT SURVEY. co
NOT USE TO ERECT FENCES, OTHER BOUNDARY STRUCTURES, OR TO %MTH Iv' BUILDING(S)
WE CERTIFY THAT THE BUILD ARE NOT IMTWN THE
)
PLANT SHRUBS. LOCATION OF YHE STRUCTURES) SHOWN HEREON is q N0. 46 510 SPECIAL FLOOD HAZARD AREA. SEE HUD MAP:
EITHER IN COMPLIANCE WITH LOCAL ZONING FOR PROPERTY LINE OFFSET I
REOUIREMENTS, OR IS EAEMPT FROM VIOLATION ENFORCEMENT ACTION e �EGIST tiO .. `501670002A DID: 4/3/1978
UNDER MASS. G.L TITLE VII. CHAP. 40A, SEC. 7, UNLESS OTHERWISE NOTED. _
THIB CERTIFICATION IS NON - TRANSFERABLE. THE ABOVE CERTIFICATIONS °Nq FLOOD HAZARD ZONE HAS SEEN DETERMINED EY SCALE
ARE MADE WITH THE PROVISION THAT THE INFORMATION PROVIDED IS ���� : AND IS NOT NECESSARILY ACCURATE. UNTIL DEFINITIVE
ACCURATE AND THAT THE MEASUREMENTS USED ARE ACCURATELY FLANS ARE ISSUED BY HUD AND/OR A VERTICAL CONTROL
LOCATED IN RELATION TO THE PROPERTY LINES. / SURVEY IS PERFORMED, PRECISE ELEVATIONS CANNOT BE
DETERMINED.
>B QQ
' 9
Q
EXISTING
HOUSE
#31 -33
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%••-,>€ ms 4 �'
-4
E
'DEED DESCRIPTION DOES NOT MATHEMATICALLY CLOSE.
cONF7OURATION OF LOT IS COMPILED FROM ASSESSOR MAP
INFORMATION AND FROM UNES OF OCCUPATION. AN
INSTRUMENT SURVEY IS RECOMMENDED.
REQUESICU BYc
DRAWN BY: AJO File: OSMI1
CHECKED BY: GES.
TO /TO 30Vd ans aNV- CI NV M3N 8ZLL1?8Z8O5 LZ bT 6OOZl6Z /OT
7) ) St,-1.4._" / ( 411 - 0 ( ■ . i S 1 SQL m -\ T )41,2 .
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ACC.)1,11J DATE (MWDDP
k........-- CERTIFICATE OF LIABILITY INSURANCE 10121/10
[
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT' if the certificate holder is an ADDITIONAL INSURED, the policy(les) must bt erdorsad. If SUBROGATION IS WAIVED, SI-lief-1 to
t ha terms and conditions of the policy. oerta!rt poIit.:es may require an Qndorsernent. A staternent en this certificate does not confer rights to the
certificate holder in lieu of such andorsoment(s).
/--. I
I PRODUCER 41:3-594-5984 CONTACT 1 IAAME
PHILLIPS INSURANCE AGENCY INC. 413?-94
-5999 i PHONE
i , El■ki!
L ot', Nio.
97 CENTER STREET E.A40.1.
ADDP.ESS.
CHICOPEE, MA 01013 pptrioucEs
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Ka Woo 2
1_,CUSTCPER ID*
-I ER(S) AFF:AONCi COVERAGE
! NALic
J 1 2572 I —
NSURED Snows Enterprises
L
Kenneth Snow
11 Lamson Ave 1 IN1'./RER A .
Selective Insurance
I IMSURER B :
..........._...................._............*..,_ ....._........._,..........._ iNSURER C :
Belchertown, MA 01007
rtc;ORFR D •
i iNtit :PPR w. '
A i'4SUREP
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COVERAGES CERTIFICATE NUMBER: REVI:SION NUMBER:
THIS I' T5 TETIFY_THAT THE Pos riF.'; nF itviiisao , !Sin BELOW 1-,IIVE BEEN IS7 IC THE rM.IREn hilmEn eiEnvE FCIR O H E P i PENCE
INDICATED MOT,NiTHSTANDING ANY REQUIRE VENT 'EE/ OR CONDITION OF *Ft CONTRACT 0; OTHER DOCUMENT WITH RESPECT TO WHICH 'HS
CERTIFICATE VI AY BE CsSI.IED OR MAY PERTAIN, PIE riSt.IRANCE 1I.RFORDED B`,' THE PO_ CIE:: DESCRIEiED HEREIN IS SUBJECT TO ALL THE TERMS
IO
EXCLUSNS AND SON 'DITIONS OR 1 POLK:1E3 LIMITS SHOWN MA' HAVE BEEN REDUCE.D BY PA CLAP
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CERTIFICATE HOLDER_ ,..., CANCELLATION
CITYNOR
City of Northam pton
Memorial Hall
F
240 Main St:, Suite 3
Northampton, MA 01090 fi'l 1
SHOULD ANY OF THE DESCRIBED POLICIES BE CANCELLED BEFORE '
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED !IN
ACCORDANCE WIN THE POLICY PROVISIONS.
....._
Arri-icialz.ec REPP.ESENTA i
PAA-
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g,1988-2009 ACORD CORPORATION All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marKs of ACORD
10121/2010 15.'36 413569230E DIANE MASON AciENCY PAGE 01/1
' ^r- Y -R DT CERTIFICATE OF LIABILITY INSURANCE D io /IIIizo o
RP ODUCER 413.569-2307 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
DIANE L MASON AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
FARM FAMILY CASUALTY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
j ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
I 504 COLLEGE HIGHWAY
SOUTHWICK, MA 01077 INSURERS AFFORDING COVERAGE
INauffEn rn.ugER FARM FAMILY CASUALTY INSURANCE
DBA SNOWS E'OTERPRISES INSURER a;
11 LAMSt7N AVENUE NSURER c
BELCHERTOVVN, MA 01007.5710 NSUIeER D ,
- --H..— I INSLI E E'.
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
sANEE ....... ._ PCUCY MOW!' . , .,• ' _ UNITS - . ..
Y PE OF IN R .: ; _•
T P t Y fiFPECIIStE
GENERAL OMMRRC ALL G & MERAL uA5! TY EACH CCCURRSNCE S
I ... 1 LI
I + ! FIRE DAMAGE (An, ane Ere) $
' I MED EXP y perear) #
� LLAIAI9 MADE J OCCUR � (An arm __.. _...... _..
I ..
PERSONAL & ADV Ih URY % ..... _, _.
_._
I i GENERAL AGGREGATE 1 3
1 JIG C G _,..
L I � PRODUCTS COMP/OP AGO { $ .
t#EN L AGGREGATE JMIT APPLIES PER. I
'P OLICY ;: r ...
AUTOMOBILE LIABILITY i • COMBINED SINGLE LIMIT $
I (Ea accident)
I + i ANY AUTO
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- aGMEDULED AUCO� To rIL por's") RY
ALL OWNED AUTOS fIOD INJ --- _- I$
I
i
I
i 1 H!RED AUTOS ! ! BODILr ecY eident) INJURY a
:.' •I I NON•CWNED AUTOS ;
{pe
' ..- ..., ... _._....... .... ; FROPERTY DAMAGE $
(Per accident) ... :_. _
1 I *AMOR UAfi)LITT I I AUTOONLY - EA ACCIDENT 3
_
ANY AUTO OTHER THAN 6
EXCESS LIABM,ITY AUTOGNI.Y,
G
ca P
-
I EACH OCCURRENCE $
OCCUR I.. I CLAIMS M ADE, 1GGPEiCMtF P .. ..., ...
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RETENTION �_
x
WORKERS COMPENSATION AND I , i X
� T03Y. {-I.M.ITS I q 5 .. .-.-
. DISEASE - EA EMPLOYEE 3 100,000
—1 -- j Li.. DISEASE - POLICY LIMIT 5 500,000
1
; DESCRIPTION OF OPORATIONS!LACATIONSAYGH OLES /EXOI.IIB4ONE ADDEO EY ENDORSEMENTISPECIAL PROVISIONS
CARPENTRY
CERTIFICATE i HO DER 1 I AODITIONAL INSURER LETTER: CANCELLATION .
SHOULD ANY OP THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, HUT FAILURE TO DO SO SHALL.
CITY OF NORTHAMPTON IMPOSE MO OBLIGATION OR UABIUTY OK ANY KIND UPON THE INSURER, ITS AGENTS Oft
C
NORTHAMPTON, MA ftwateNparvEs.
AUTHORIZED REPRESENTAflVE M
A5-5 (7197) _ - —��+`
COk 2 — .. 0 ACO - f CORPORATION 1988
t '
NSSA�H(7STTS, DRIVER'S
- - LICENSE M
u �,t �.3"'_,''
.: "'- 9a END 4d NU
. , ; s O7,401',0 NONE 597 Qs
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1 - ` B. is s5x' i
A KENO H VI
_ __ a 15 LAMSON AVE
_. - BELCHERTOWN, MA 01007.971
/7Y ( — l5 DO 08.09.2010 Rev 01-15400
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;71' e. - (Jc m,,Zoita 6� i 6 (e JJQ"CIl"a eez
Office of Consumer Affairs & Bdsiness Regulation
a l HOME IMPROVEMENT CONTRACTOR -
AI Registration. .102745 Type
4 _ Expiration: 7/2/2012 Individual
KENNETH H. SNOW
Kenneth Snow
11 LAMSON AVE. G-�--,
Belchertown, MA 01007 Undersecretary
\ 1i ,aclttr∎ctt*. - Dnliarinacni of Public `+af t
' Board of Buiidint4 Rrt2,trlatitnrs anti iandarda
sn... Construction Supervisor License
License: CS 52727
Restricted to: 00
KENNETH H SNOW
11 LAMSON AVE
BELCHERTOWN, MA 01007
,..._? - _ -�",� Lxp;rairon: 6/13/2011
Q I,ow,,i“,.r TrK: 19309
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two family
dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two -year period shall not be considered a
home owner."
The building department for the City of Northampton wants person(s) who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
regulations. The inspection process requires that the building department be called to
inspect work at various stages, which include foundation /footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
jermits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can D1LAY the project until such time as the proper permits and inspections are
made
I, under stand the above.
(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to
Date
Address of work
location
The Commonwealth of Massachusetts
Department of Industrial Accidents
5' —14fa.. M Office of Investigations
_
600 Washington Street
_.._— Boston, MA 02111
� . www.massgov /dia
-Workers' Compensation Insurance Affidavit Builders/ Contractors /Electricians/Plumbers -
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): 1�t .. 4t k " \ }k . SNOB
Address: 11 ■P\MSuA iJE..
City /State/Zip: t J � L-Ctkak.0) , Z 0 ilk . o t Phone. #: 6413) ).31- (oS ^b 1.
Are you an employer? Check the appropriate box: %'
Type of project (required):
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub- contractors 6. ❑ New construction
2. am a sole proprietor or partner- listed on the attached sheet 7. faRemodelin¢
ship and have. no employees These sub - contractors }nave. 8. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance
• . Building - . 'addn
itio
insurance+ $ 9
_
required.] 5• ❑ We are a corporation anti 10 ❑Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have xercised their 11. Plumbing r
g t ❑ mg epairs or additions
myself [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance require&J t c. 152, § 1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 0
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether ar not those entities have
employees. If the sub - contractors have employees, they must provide their workers' comp. policy number.
./. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: :4k ` t A \ L� CASLAJNL. I rJ S L -l2P\tJ CS C '
Policy # o r Self-ins. Lic. #: �C0W b 1 % Expiration Date: 14 1 O l
Job Site Address: 33 • N 0.k. t \tvMP t» i " City/State/Zip Pt f)b -
Attach a copy of the workers' compensation policy declaration page (showing the policy nu and expiration date).
Failure to secure coverage, as required under. Section'25A ofMGL c. 152 can lead to the imposition of crimina1 penalties of a
fine up to $1 500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK -ORDER and a fine
of up to $250.00 a day against the violator Be advised that a copy of this statement may be forwarded to the Office of
Investigaiions'of the DIA for insurance a verifca ion . __ w
_ I do hereby ce u der the pains and i , s ofperju y that the information provided srbov -e_ itlrue_and-corr et
Sisn atur . v Date: 10 1 4) . ;. c7
Phone #: (-k 3) oe)1- (oS ( -- . .
Official use only. Do not write in this area, to be cornipleted by city or townofficiaL
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk . 4. Electrical Inspector 5. PIumbing Inspector
6. Other r-
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : ` �' ` ' .
`
`�
Licen a Nu ber
L z(L :oL,J ✓`1/\ O tc>6 (o t5 t t
Address Expir ion D to
(Lko))
Signature -- - phone
�—..
8,.` Registered:. HomeImprovementC , .___. :unit.- f,a_, . , .. -.„ Not Applicable ❑
/d 7q5
Company Name Registration Nu ber
7702//
Address Expiration Date `
Telephone
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes No ❑
The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two - year period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition El Replacement Windows Alteration(s) ® Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ® New Signs [0] Decks [❑ Siding [O] Other [O]
Brief Description of Proposed
Work: RL ��lL� 1�c�.� p J ` Z C <t � C��� /� ,,,,,
Alteration of existing bedroom Yes 7C No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes A No
Plans Attached Roll - Sheet
6 '1f itew:hauseEand 'r adiii ian lei`° xts`itinq. itoi srnq atom i tithe foiiQwttip:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN .
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I , f\L--- (6= - -T. &L.Pg\i, \J 3 .1 (`1F PC,L. (L , as Owner of the subject
property �(
hereby authorize " c-c `` J(,)-
action my b 1 alf\in II atters r ative to work authorized by this building permit a plicat' n.
Sign of O'w. ne 1 Date (!
I, �� - ). t t■i, � : A 1* 5 , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
r E- f . St..LL
PrintN
Signature of Own-r /Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
U „` C This column to be filled in by
, Building Department
Lot Size i 5 }.s_v _ 5. }c3 u . i
Frontage 1 1 C _ 3
Setbacks Front 3 p i (3
Side L: ty : R:1-13-31 L: R:' 3..5'
Rear ri - i I �l
Building Height t o; i i 5
Bldg. Square Footage il61.51 ryci % Itt (3∎ i
Open Space Footage
(Lot area minus bldg & paved 1 l3 1 x 1,11.1 23
parking)
# of Parking Spaces Eu71 if b
Fill: A
(volume & Location)
I N t A
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO CO DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book = i Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO S DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO ►�4
_^
IF YES, describe size, type and location: I
D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO ei
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO (a
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
C
City of Northampton , i gg , r .
Building Department -� e : It s i , £ ,
212 Main Street L E _ �1 . ' 1 « 5 ; 1 : ` � ..:,,,A-,,,,i_;,,,,. F
Room 100 G
Northampton, MA 01060 'w '� �,
phone 413- 587 -1240 Fax 413- 587 -1272 $ C` A P k
��mW #. ,t Eft
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION
1.1 Property Address: C' LC1� This section to be completed by office
33 G(1%--,7 F\ - • QC� /_ ., M L ot Unit
\& -'
� ` / (' V �o''oe � � ' Overlay District
fiat St. District ' CB District
SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
C � _ O ) ' - 1' L 1 L�._( `T t l`� Stl.v� 2 ��` / 5u -AN �R �,� c�ty1��
Nam (Print) 11)t
//11 ll�7yy �'tJ�
1fC�L 2 Telephone
Signature \ r
2.2 Auth ized ent:
Nam Current Mailing Address:
/ � '�� (k1 a31 (o5
E. 't6 v , A..)
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of NI 1 i Construction from (6)
3. Plumbing Nk Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection NA I
6. Total= (1 +2 +3 +4 +5) Check Number jlJlo
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
•
File # BP- 2011 -0375
APPLICANT /CONTACT PERSON KENNETH H SNOW
ADDRESS/PHONE 11 LAMSON AVE BELCHERTOWN (413) 237 -6562
PROPERTY LOCATION 33 GRANT AVE
MAP 25C PARCEL 103 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid ,a P 53
Typeof Construction: REBUILD FRONT PORCH (SAME FOOTPRINT)
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 52727
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
ORMATION PRESENTED:
pproved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission _ Permit DPW Storm Water Management
Demolition Delay
/
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
•
BP- 2011 -0375
GIs #: COMMONWEALTH OF MASSACHUSETTS
ef' CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2011 -0375
Project # JS- 2011- 000624
Est. Cost: $5200.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KENNETH H SNOW 52727
Lot Size(sq. ft.): 5270.76 Owner: ELMWOOD TITLE LLC
Zoning: URB(100)/ Applicant: KENNETH H SNOW
AT: 33 GRANT AVE
Applicant Address: Phone: Insurance:
11 LAMSON AVE (413) 237 -6562 WC
B ELCH ERTOW NMA01007 ISSUED ON:10/26/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: REBUILD FRONT PORCH (SAME FOOTPRINT)
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 10/26/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner